It is extremely important to know the satisfaction of the persons served. We need to know if the care given to you was satisfactory; if the call bell was answered in a reasonable period of time, if the staff listened to your concerns, if you participated in your discharge plans and if you would recommend MSRC to your friends. In addition, MSRC looks at outcomes in terms of effectiveness, efficiency, and accessibility as a rehabilitation facility, from functional and financial perspectives. These outcomes tell us if MSRC provides exemplary services in a timely and cost efficient manner.

Furthermore, the Commission on Accreditation of Rehabilitation Facilities (CARF) standards requires us to collect and employ information in a manner that is useful and that contributes to administrative and clinical decisions. This information supports current performance improvement initiatives and identifies new areas for discussion.

Finally, CARF requires that valid and reliable information be shared with consumers and other stakeholders. For example, the persons served are provided performance related information during the preadmission process. In addition, the persons served will also find performance information posted on bulletin boards located on the various units.

A stakeholder is any entity that has an interest in the rehabilitation center’s affairs. This includes, but is not limited to, consumers (patients), staff, referring physicians and agencies, referring hospitals, insurance companies, as well as community and government agencies. Constant communication with these stakeholders helps the rehabilitation center provide a more seamless treatment experience to the persons served.

Outcomes information is shared with stakeholders in a variety of ways including admission packets, unit postings, newsletters, the WEB site, conferences, and mailings.

Outcomes are used to support performance improvement initiatives. Data is analyzed to compare Mount Sinai Rehabilitation Center’s outcomes against past performance and regional averages (benchmarks) to determine our efficacy relative to other facilities. Functional indicators such as FIM change as well as Length of Stay (LOS) data are used to make programmatic changes which increase effectiveness and efficiency. This analysis of outcome data is helpful in understanding the relationships between indicators; in other words the impact one indicator may have on other indicators. This, in turn, broadens our understanding of performance changes and enhances our ability to maximize patient outcomes.

MSRC uses the Functional Independence Measure (FIM) tool to measure functional outcomes. The data is collected upon admission and discharge. The tool is comprised of six sections (self-care; sphincter control; transfers; locomotion; communication; social cognition) with a total of 18 items. The highest achievable score is seven for each item and the maximum total score possible on the tool is 126. The higher your score the greater your functional independence.

Other outcomes relate data to length of stay, financial resources, and demographics, are also collected and analyzed.

Data collection is accomplished in a number of ways and is done by the entire rehabilitation interdisciplinary team, covering many indicators.

The Admissions Coordinators collect demographic and financial information at the time of admission. This information is helpful upon discharge when, for example, we contact persons served and ask them about their inpatient stay at the MSRC. In addition, staff record FIM information upon admission and discharge on the Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI). This information is then entered into the Uniform Data System for Medical Rehabilitation.  Most outcome related reports are generated via this database.

Finally, management performs monthly closed chart reviews. These reviews allow managers to examine all documentation for completeness and consistency.

Below are a few of the outcome related indicators that are monitored on a regular basis:

• LOS—by Case Mix Group (CMG), by payer
• Onset Days—by CMG
• FIM scores and LOS efficiencies (FIM change per day )—by CMG
• Relationships between LOS and onset days and FIM scores
• Relationships between relative weights (on admission) and FIM Change, LOS Efficiency, and Discharge Setting
• Disclosure statement: Is it completed correctly?
• Difference between the estimated LOS (ELOS) and actual LOS (ALOS)
• Discharge Destination
• Satisfaction of the persons served